Provider Demographics
NPI:1245926070
Name:UPLIFT MENTAL HEALTH SERVICES, PLLC
Entity type:Organization
Organization Name:UPLIFT MENTAL HEALTH SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:MS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:336-459-9565
Mailing Address - Street 1:3064 WAKE FOREST RD # 1405
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7844
Mailing Address - Country:US
Mailing Address - Phone:336-459-9565
Mailing Address - Fax:
Practice Address - Street 1:9121 ANSON WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615
Practice Address - Country:US
Practice Address - Phone:910-505-0477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-14
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty